Complaint Investigation Report

The investigation revealed the following: Regarding allegation: Facility staff did not notify authorized representative of incident. It is alleged facility staff did not notified R1’s responsible party regarding incidents that occurred on 5/7/25 and 6/11/25. Interviews with residents revealed facility staff notify their responsible party when necessary. Interviews with staff revealed Administrator or LVN are responsible for notifying responsible parties when incidents take place. Per administrator, on 5/8/25 administrator contacted R1’s responsible party via telephone at least three times and was unable to leave a voice message. Interview with R1’s responsible party revealed upon visiting R1 at the facility on 5/8/25, administrator stated to them that they had attempted to notify them of the bruise but had not been able to reach them. Regarding the incident on 6/11/25 responsible party called around 3:15pm and was asked to call police officer for details regarding an incident. Incident report dated 5/8/25 notes administrator notified responsible party. Incident report dated: 6/11/25 does not note responsible party was notified. Per police report reviewed, South Pasadena Police officer responded to a battery assault at the facility at 12: 32pm. Facility staff failed to notify R1’s responsible party of the incident that took place on 6/11/25 and requested to call police officer for details of the incident. Therefore, the allegation is substantiated.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview was conducted and a copy of this report, LIC 9099D, and appeal rights were provided.